Babies have low levels of vitamin K in their bodies at birth. Without vitamin K, babies are at risk of getting a rare bleeding disorder. A single vitamin K injection given at birth is the most effective way of preventing this.Parents, did you provide your newborn with the Vitamin K injection? As I report today, doctors have given this shot for decades. They say it's extremely effective at preventing spontaneous bleeding, which can cause severe problems and even death. I met Dr. Valencia Walker, a neonatologist and assistant clinical professor at the David Geffen School of Medicine at UCLA, who recommends the shot for all of her patients. "When you look at something like a one-time shot, versus having a baby that can die from something that is completely preventable… that's why we do the Vitamin K injection for all of our babies," Walker says. But a small number of parents are refusing the shot. It's hard to know how many people are turning it down. The Centers for Disease Control and Prevention says the information is not tracked by any agency at the county, state or national level.
It doesn't seem to be happening a lot in formal hospital settings. Walker says she sees one or two families a week who opt out. Neonatologists we spoke to at other hospitals say they hardly ever see it. But it's clear that it is happening – particularly at places like South Coast Midwifery and Women's Health Care in Irvine. South Coast Midwifery assists with about 250 births a year, and administrative director Lindsey Holmes estimates that more than half of her clients choose to skip the Vitamin K injection. I spoke with several other Southern California midwives, who said a majority of their patients forego the shot. Holmes did the same thing: "I'll be honest and say, I don't want my baby to get a shot, unless it's necessary," she says. The 31-year-old Holmes gave birth to both of her sons at home, with the help of one of the center's midwives. Instead of the shot, she chose to give her newborns oral Vitamin K drops. That's something South Coast Midwifery and others routinely offer as an option.
"We can achieve the same results, and not have to poke my baby, and not have to pump him with a pharmaceutical, at such a young age - I mean, minutes old"' Holmes says. The CDC says the other chemicals in the shot are a benign mix that keeps the Vitamin K stable. Offering oral Vitamin K drops as an alternative to the shot goes against the recommendation of the American Academy of Pediatrics. Dr. Walker, of UCLA, says the problem with oral Vitamin K is there's no formulation or dosage that's approved in the U.S. And, she says it's hard to predict how much Vitamin K a baby is absorbing from the drops. A Canadian study published yesterday in the journal Pediatrics finds a similar profile of the people who refuse the Vitamin K shot: It says they tend to use midwives or give birth at home. And, it says, they're more likely to refuse childhood vaccinations. A CDC study in Tennessee found that between January-October 2013, the parents of 28 percent of children born at local private birthing centers in the state declined the Vitamin K shot.
"It's very concerning," says Dr. William Benitz, chief of neonatology at the Stanford University School of Medicine, and the Lucile Packard Children’s Hospital. He says parents who refuse the Vitamin K shot probably don't realize that before it was developed about 50 years ago, roughly one percent of babies had significant bleeding within the first week of life. "The invisibility of the threat is a real challenge because it makes it difficult for people to comprehend what it is that they're defending their baby against," Mortiz says. The threat became a little more visible in recent months. In May, the Monroe Carell Jr. Children's Hospital at Vanderbilt, in Tennessee, said it had treated seven babies who didn’t get the shot, and who developed Vitamin K deficiency bleeding. Four had bleeding in the skull. The CDC investigated four of these cases in November 2013. In California, state public health officials say they don’t know if there have been any cases here, since they don’t track that information.
If you did - or did not - provide your newborn with the Vitamin K shot, we want to hear from you. How did you make your decision? Your experience could inform future reporting.A single dose (1.0 mg) of intramuscular vitamin K after birth is effective in the prevention of classic HDN. Either intramuscular or oral (1.0 mg) vitamin K prophylaxis improves biochemical indices of coagulation status at 1-7 days. Neither intramuscular nor oral vitamin K has been tested in randomized trials with respect to effect on late HDN. Oral vitamin K, either single or multiple dose, has not been tested in randomized trials for its effect on either classic or late HDN. Vitamin K deficiency can cause bleeding in an infant in the first weeks of life. This is known as Hemorrhagic Disease of the Newborn (HDN). HDN is divided into three categories: early, classic and late HDN. Early HDN occurs within 24 hours post partum and falls outside the scope of this review. Classic HDN occurs on days one to seven;
common bleeding sites are gastrointestinal, cutaneous, nasal and from a circumcision. Late HDN occurs from week 2-12; the most common bleeding sites are intracranial, cutaneous, and gastrointestinal. Vitamin K is commonly given prophylactically after birth for the prevention of HDN, but the preferred route is uncertain. To review the evidence from randomized trials in order to determine the effectiveness of vitamin K prophylaxis in the prevention of classic and late HDN. Main questions are: Is one dose of vitamin K, given after birth, able to significantly reduce the incidence of classic and late HDN? Is there a significant difference between the oral route and the intramuscular route in preventing classic and late HDN? Are multiple oral doses of vitamin K, given after birth, able to significantly reduce the incidence of classic and late HDN? All trials using random or quasi-random patient allocation, in which methods of vitamin K prophylaxis in infants were compared to each other, placebo or no treatment, were included.
Data were extracted independently by each author and were analysed with the standard methods of the Cochrane Collaboration and its Neonatal Review Group, using relative risk, risk difference and weighted mean difference. Two eligible randomized trials, each comparing a single dose of intramuscular vitamin K with placebo or nothing, assessed effect on clinical bleeding. One dose of vitamin K reduced clinical bleeding at 1-7 days, including bleeding after circumcision, and improved biochemical indices of coagulation status. Eleven additional eligible randomized trials compared either a single oral dose of vitamin K with placebo or nothing, a single oral with a single intramuscular dose of vitamin K, or three oral doses with a single intramuscular dose. None of these trials assessed clinical bleeding. Oral vitamin K improved biochemical indices of coagulation status at 1-7 days. There was no evidence of a difference between the oral and intramuscular route in effects on biochemical indices of coagulation status.